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目的客观评价莫西沙星治疗社区获得性感染致呼吸衰竭行有创机械通气患者的临床疗效和安全性。方法选择2005年1月至2008年6月中国医科大学附属第四医院收治的需行有创机械通气患者130例。42例重症社区获得性肺炎(CAP)且无基础疾病的患者随机分为:莫西沙星组24例(治疗组1)和头孢呋辛钠联合阿奇霉素组18例(对照组1)。两组均续贯治疗给予阿米卡星联合阿奇霉素口服,平均疗程10 d。88例慢性肺疾病合并下呼吸道感染者随机分为莫西沙星组42例(治疗组2)和头孢哌酮舒巴坦(舒普深)联合阿奇霉素组46例(对照组2);两组均续贯治疗给予阿米卡星联合阿奇霉素口服,平均疗程14 d。结果治疗组1、2临床有效率(95.83%、92.86%)分别高于对照组1、2(83.33%、86.96%)。临床症状改善及理化检查好转时间治疗组明显优于对照组(P<0.05);莫西沙星对青霉素和其他β内酰胺类抗生素(如口服头孢菌素类)产生耐药性的肺炎链球菌菌株、四环素和大环内酯类耐药的菌株、院内致病菌菌株敏感率明显提高,有效率分别为:莫西沙星84.85%、头孢呋辛钠44.44%、阿奇霉素51.85%、头孢哌酮舒巴坦71.58%,有效率差异有统计学意义(P<0.01)。不良反应发生多以消化不良、静脉炎、肝功能异常为主,治疗组1、2不良反应发生率低于对照组1、2。结论莫西沙星在治疗社区获得性中重度感染致呼吸衰竭有创性机械通气患者感染中安全、有效,敏感性高。
Objective To objectively evaluate the clinical efficacy and safety of moxifloxacin in the treatment of community-acquired respiratory infection-induced respiratory failure in patients with invasive mechanical ventilation. Methods From January 2005 to June 2008, the Fourth Affiliated Hospital of China Medical University admitted to the need for invasive mechanical ventilation in 130 patients. Forty-two patients with severe community-acquired pneumonia (CAP) who did not have underlying disease were randomly assigned to one of 24 patients in the moxifloxacin group (treatment group 1) and 18 to the cefuroxime sodium group in combination with azithromycin (control group 1). The two groups were treated with continuous oral administration of amikacin and azithromycin oral, the average course of 10 d. 88 chronic lung disease patients with lower respiratory tract infection were randomly divided into moxifloxacin group 42 cases (treatment group 2) and cefoperazone sulbactam (Shu Pu deep) combined azithromycin group 46 cases (control group 2); both groups were Continued treatment of oral administration of amikacin azithromycin, the average course of 14 d. Results The clinical effective rate of treatment group 1 and 2 (95.83%, 92.86%) was higher than that of control group 1 and 2 (83.33% and 86.96% respectively). The improvement of clinical symptoms and improvement of physical and chemical examination in the treatment group were significantly better than those in the control group (P <0.05). Streptococcus pneumoniae strains resistant to penicillin and other β-lactam antibiotics (such as oral cephalosporins) , Tetracycline and macrolide resistant strains, the sensitivity rate of nosocomial pathogenic bacteria significantly increased, the effective rates were: moxifloxacin 84.85%, cefuroxime sodium 44.44%, azithromycin 51.85%, cefoperazone Shiba Tanzania 71.58%, the effective difference was statistically significant (P <0.01). Adverse reactions occurred mostly dyspepsia, phlebitis, liver dysfunction, the incidence of adverse reactions in treatment group 1,2 was lower than the control group 1,2. Conclusion Moxifloxacin is safe, effective and sensitive in the treatment of patients with respiratory failure due to moderate or severe infection of community-acquired and mechanical ventilation.